Comparison of Outcomes of Synthetic Mesh vs Suture Repair of Elective Primary Ventral Herniorrhaphy

Nguyen, Mylan T.; Berger, Rachel L.; Hicks, Stephanie; Davila, Jessica A.; Li, Linda T.; Kao, Lillian S.; Liang, Mike K.

doi:10.1001/jamasurg.2013.5014

Cited by 189 publications

(101 citation statements)

References 19 publications

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“…This is comparable with the available literature, which describes a recurrence rate of approximately 2% for mesh repair, rising up to 8% for suture repair [24, 25]. However, recently the cohort study of Christoffersen et al showed that the total cumulated recurrence rate after primary repair was 10% for mesh repair and 21% for sutured repair after 55 months of follow-up ( p = 0.001) [26], which is a surprisingly high percentage.…”

Section: Discussionsupporting

confidence: 87%

The feasibility of local anesthesia for the surgical treatment of umbilical hernia: a systematic review of the literature

Jairam

Kaufmann

Muysoms

et al. 2017

Hernia

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BackgroundYearly approximately 4500 umbilical hernias are repaired in The Netherlands, mostly under general anesthesia. The use of local anesthesia has shown several advantages in groin hernia surgery. Local anesthesia might be useful in the treatment of umbilical hernia as well. However, convincing evidence is lacking. We have conducted a systematic review on safety, feasibility, and advantages of local anesthesia for umbilical hernia repair.MethodsA systematic review was conducted according to the PRISMA guidelines. Outcome parameters were duration of surgery, surgical site infection, perioperative and postoperative complications, postoperative pain, hernia recurrence, time before discharge, and patient satisfaction.ResultsThe systematic review resulted in nine included articles. Various anesthetic agents were used, varying from short acting to longer acting agents. There was no consensus regarding the injection technique and no conversions to general anesthesia were described. The most common postoperative complication was surgical site infection, with an overall percentage of 3.4%. There were no postoperative deaths and no allergic reactions described for local anesthesia. The hernia recurrence rate varied from 2 to 7.4%. Almost 90% of umbilical hernia patients treated with local anesthesia were discharged within 24 h, compared with 47% of patients treated with general anesthesia. The overall patient satisfaction rate varied from 89 to 97%.ConclusionLocal anesthesia for umbilical hernia seems safe and feasible. However, the advantages of local anesthesia are not sufficiently demonstrated, due to the heterogeneity of included studies. We, therefore, propose a randomized controlled trial comparing general versus local anesthesia for umbilical hernia repair.

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Section: Discussionsupporting

confidence: 87%

The feasibility of local anesthesia for the surgical treatment of umbilical hernia: a systematic review of the literature

Jairam

Kaufmann

Muysoms

et al. 2017

Hernia

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“…However, many studies demonstrate an increased risk for wound complications with mesh placement including infections, seromas, and mesh erosions [3,4]. The risks of these complications are affected by where the mesh is placed.…”

Section: Introductionmentioning

confidence: 99%

Mesh Location in Open Ventral Hernia Repair: A Systematic Review and Network Meta‐analysis

et al. 2015

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There is no consensus on the ideal location for mesh placement in open ventral hernia repair (OVHR). We aim to identify the mesh location associated with the lowest rate of recurrence following OVHR using a systematic review and meta-analysis. A search was performed for studies comparing at least two of four locations for mesh placement during OVHR (onlay, inlay, sublay, and underlay). Outcomes assessed were hernia recurrence and surgical site infection (SSI). Pairwise meta-analysis was performed to compare all direct treatment of mesh locations. A multiple treatment meta-analysis was performed to compare all mesh locations in the Bayesian framework. Sensitivity analyses were planned for the following: studies with a low risk of bias, incisional hernias, by hernia size, and by mesh type (synthetic or biologic). Twenty-one studies were identified (n = 5,891). Sublay placement of mesh was associated with the lowest risk for recurrence [OR 0.218 (95% CI 0.06-0.47)] and was the best of the four treatment modalities assessed [Prob (best) = 94.2%]. Sublay was also associated with the lowest risk for SSI [OR 0.449 (95% CI 0.12-1.16)] and was the best of the 4 treatment modalities assessed [Prob (best) = 77.3%]. When only assessing studies at low risk of bias, of incisional hernias, and using synthetic mesh, the probability that sublay had the lowest rate of recurrence and SSI was high. Sublay mesh location has lower complication rates than other mesh locations. While additional randomized controlled trials are needed to validate these findings, this network meta-analysis suggests the probability of sublay being the best location for mesh placement is high.

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“…Although recurrence rates were found to be lower, complications such as seroma and surgical site infection were observed at higher rates in a study [13]. In in-lay procedures, the most serious complications are intestinal erosions and enterocutaneous fistulas.…”

Section: Introductionmentioning

confidence: 71%

Reduction of adhesions with autogen tissue-covered polypropylene mesh implants for incisional hernia repair: an experimental study

Ersöz¹,

Deniz²,

Düzköylü³

et al. 2015

Eur Surg

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Background Incisional hernia is a complication that is encountered with a rate of 2-11 % and can lead to morbidity, work loss, and even mortality. Prosthetic materials that are used in hernia repair are still being tested, and the ideal one has not been proposed yet. While the recurrence rates with primary repair are found to be 30-50 %, these rates are decreased to 0-15 % with mesh repair. These rates emphasize the importance of meshes. The most important criteria in their usage are the advantages and disadvantages of types of meshes. Our aim is to cover the mesh with the subject's own collagen tissue, then to repair the defect with this autogen collagen-covered propylene mesh, and lastly, to prevent or decrease adhesions against the mesh.Methods A total of 14 male, healthy, 250-300 g WistarAlbino rats were included in the study. They were separated into two equal groups as Group A (control group) and Group B (study group). In Group A, full-thickness defects were repaired with polypropylene meshes. In Group B, meshes of the same size were placed under the skins of the rats and excised on the ninth day. After creating a full-thickness defect, it was repaired with the rat's own mesh. On the 21st day, in both groups, the adhesions between intra-abdominal organs and the mesh were evaluated by two independent observers according to adhesion scoring system. The groups were compared in means of fibrosis and inflammation scores. The pathologist was not informed about which preparate belonged to which group.Results In Group A, adhesion area, adhesion strength, inflammation, collagen tissue, and fibroblast activity were significantly higher than Group B.Conclusions According to our results, after in-lay placement of autogen tissue-covered polypropylene meshes, adhesions can decrease and complications due to intra-abdominal adhesions can be prevented, and relatively low costs may contribute to health expenditure.

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Comparison of Outcomes of Synthetic Mesh vs Suture Repair of Elective Primary Ventral Herniorrhaphy

Cited by 189 publications

References 19 publications

The feasibility of local anesthesia for the surgical treatment of umbilical hernia: a systematic review of the literature

The feasibility of local anesthesia for the surgical treatment of umbilical hernia: a systematic review of the literature

Mesh Location in Open Ventral Hernia Repair: A Systematic Review and Network Meta‐analysis

Reduction of adhesions with autogen tissue-covered polypropylene mesh implants for incisional hernia repair: an experimental study

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